NPIMap

Organization Active NPI

Active Body Chiropractic LTD

  • Chiropractor
  • Chicago, IL
National Provider Identifier
1477582302
Registry record updated Oct 25, 2012
On this page

Key facts

NPPES NPI Registry
Primary specialty
ChiropractorTaxonomy code 111N00000X
License
060-008054 Issued in IL
Legal business name
ACTIVE BODY CHIROPRACTIC LTD
Practice address
1600 S Indiana Ave
Suite 2
Chicago, IL 60616-4732
Phone
(312) 922-9868
Fax
(312) 922-9869
NPI assigned
Jul 2, 2006
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Oct 25, 2012

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Dr. Dylan P Drynan, DCNPI 1003845959
Title
Vice President / Coo
Phone
(312) 922-9868

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
ChiropractorGroup: 193400000X SINGLE SPECIALTY GROUP 111N00000X 060-008054 IL Primary

Addresses

Primary practice location

1600 S Indiana Ave
Suite 2
Chicago, IL 60616-4732

Mailing address

1600 S Indiana Ave
Suite 2
Chicago, IL 60616-4732
Phone (312) 922-9868

Other identifiers 1

IdentifierTypeStateIssuer
01632378OtherILBLUE CROSS BLUE SHIELD ID

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in IL

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20121019000436 IL Part B Supplier - Clinic/Group Practice 7416107891 Receives reassigned benefits from 3 practitioners
Practice locations: Chicago, IL

National Provider Directory

National Provider Directory

Locations

1600 S Indiana Ave
Ste 2
Chicago, IL 60616
Phone (312) 922-9868

1509 S State St
Chicago, IL 60605
Phone (312) 344-1384

Practitioners & affiliated clinicians

Practitioners 4

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1151798400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1351123200000",
    "number": "1477582302",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1600 S INDIANA AVE",
            "address_2": "SUITE 2",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606164732",
            "telephone_number": "312-922-9868",
            "fax_number": "312-922-9869"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1600 S INDIANA AVE",
            "address_2": "SUITE 2",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606164732",
            "telephone_number": "312-922-9868",
            "fax_number": "312-922-9869"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ACTIVE BODY CHIROPRACTIC LTD",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-07-02",
        "last_updated": "2012-10-25",
        "status": "A",
        "authorized_official_last_name": "DRYNAN",
        "authorized_official_first_name": "DYLAN",
        "authorized_official_middle_name": "P",
        "authorized_official_title_or_position": "VICE PRESIDENT / COO",
        "authorized_official_telephone_number": "312-922-9868",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DC"
    },
    "taxonomies": [
        {
            "code": "111N00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Chiropractor",
            "state": "IL",
            "license": "060-008054",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS BLUE SHIELD ID",
            "identifier": "01632378",
            "state": "IL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Chicago, IL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 25, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.